INDONESIA REPORT: Further Efforts Needed

ANEK meeting: the alliance promotes political and policy commitment for leprosy control.

Indonesia achieved the elimination of leprosy as a public health problem at the national level in 2000 and is making concerted efforts to further reduce the burden of the disease.

Despite this achievement, the country has the third highest number of new cases in the world after India and Brazil and has reported a constant 17,000 to 18,000 new cases a year since passing the elimination milestone.

Of its 33 provinces, 14 continue to report a prevalence rate above the elimination threshold of less than 1 case per 10,000 inhabitants. At the district level, 160 districts report a prevalence rate of above 1.

Of new cases, approximately, 10% have grade-2 disability of the hands and feet and 10% are children. New cases with visible disability are cases detected in the advanced stage of their disease. This shows that transmission in the community is continuing and that patients are not being diagnosed in a timely fashion.

More than 70% of new cases are multibacillary (MB) type, which is mainly responsible for disease transmission. These cases are at high risk of developing disabilities.

ANEK Meeting

How to address these and other challenges was the subject of the annual meeting of the National Alliance for Leprosy Elimination and Yaws Eradication (ANEK), held in Jakarta from August 29 to September 1. The alliance was established in 2003 and has produced a number of agreements and innovative strategies for tackling leprosy at the provincial and district levels.

Inaugurating the proceedings, Indonesia's

minister of health, Dr. Endang Rahayu Sedyaningsih, expressed her commitment to support leprosy control activities and encouraged ANEK members to pay greater attention to leprosy and other Neglected Tropical Diseases in their respective provinces. Earlier, she told Goodwill Ambassador Sasakawa, who attended on the opening day, "What we are doing is still not enough. We have to do more."

For the WHO, country representative Dr. Khanchit Limpakarnjanarat said Indonesia was at a "critical crossroad" in sustaining the gains of its anti-leprosy efforts. He urged that attention be focused on advocacy and awareness; sustaining leprosy expertise through capacity-building; case detection and management; and prevention of disabilities and community-based rehabilitation.

Attended by government representatives from all 33 provinces, provincial health officials, NGOs and other stakeholders, the four-day meeting agreed on the following steps:

- Develop and empower communities through Desa Sega ("alert village") so that each individual has access to qualified health care. (Desa Sega is a community mobilization program for health care, education and advocacy.)

- Have religious and community leaders play a role in the work of eliminating stigma and discrimination, making full use of the media, so that people who suspect they might have leprosy are willing to come forward to be examined.

- Intensify early case detection down to the smallest peripheral health facilities with the direct involvement of health professionals and related sectors.

- Train health-care providers, medical and paramedical students at regular intervals in the area of leprosy case management.

- Develop integrated referral and networking in leprosy services through the involvement of village midwives, village health posts, health sub-centers, health centers, general hospitals and leprosy hospitals to ensure continued and comprehensive leprosy services.

- Increase the budget allocation for leprosy services and for intensifying case detection.

- Break the chain of transmission through a new trial effort by treating sub-clinical groups, sharing the cost between central and local governments.

- Integrate leprosy services into the general health service.

- Encourage socio-economic rehabilitation by empowering people affected by leprosy through self-help initiatives supported by related sectors and stakeholders.

Leprosy FACT

244,796 new cases of leprosy were detected worldwide in 2009. 16 countries reported 1,000 or more cases, and accounted for 93% of all new cases detected. (Source: WHO)